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An algorithm was created, implemented, and refined to identify 18 VHD subtypes using 406 diagnosis, procedure, and prescription codes. Cox models were used to investigate associations with a composite endpoint of incident stroke (ischaemic, haemorrhagic, and unspecified), systemic embolism (SSE), and all-cause mortality. Among individuals with AF, the prevalence of AF with concomitant VHD increased from 11.4% (527\/4613) in 1998 to 17.6% (7014\/39\u00a0868) in 2010 and also in individuals aged over 65\u2009years. Those with mechanical valves, mitral stenosis (MS), or aortic stenosis had highest risk of clinical events compared to AF patients with no VHD, in relative [hazard ratio (95% confidence interval): 1.13 (1.02\u20131.24), 1.20 (1.05\u20131.36), and 1.27 (1.19\u20131.37), respectively] and absolute (excess risk: 2.04, 4.20, and 6.37 per 100 person-years, respectively) terms. Of the 95.2% of individuals with indication for warfarin (men and women with CHA2DS2-VASc \u22651 and \u22652, respectively), only 21.8% had a prescription 90\u2009days prior to the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Prevalence of VHD among individuals with AF increased from 1998 to 2010. Atrial fibrillation associated with aortic stenosis, MS, or mechanical valves (compared to AF without VHD) was associated with an excess absolute risk of stroke, SSE, and mortality, but anticoagulation was underused in the pre-direct oral anticoagulant (DOAC) era, highlighting need for urgent clarity regarding DOACs in AF and concomitant VHD.<\/jats:p><\/jats:sec>","DOI":"10.1093\/europace\/euz220","type":"journal-article","created":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T19:09:58Z","timestamp":1564168198000},"page":"1776-1784","source":"Crossref","is-referenced-by-count":21,"title":["Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: phenotypes, population prevalence, trends and prognosis"],"prefix":"10.1093","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-3411","authenticated-orcid":false,"given":"Amitava","family":"Banerjee","sequence":"first","affiliation":[{"name":"Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Allan","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spiros","family":"Denaxas","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anoop","family":"Shah","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2570-9812","authenticated-orcid":false,"given":"Dipak","family":"Kotecha","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences, Medical School, University of Birmingham, Birmingham B15 2TT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pier D","family":"Lambiase","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars H","family":"Lund","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Hemingway","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,8,13]]},"reference":[{"key":"2019120304004921600_euz220-B1","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1093\/europace\/eux240","article-title":"Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana 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